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PublicationMortality Risk Information, Survival Expectations and Sexual Behaviors(2020-01-29) Ciancio, Alberto; Delavande, Adeline; Kohler, Hans-Peter; Kohler, Iliana V.; Ciancio, Alberto; Delavande, Adeline; Kohler, Hans-Peter; Kohler, Iliana V.Individuals in low-income settings are often overly pessimistic about their own survival, suggesting that better knowledge about survival risks might encourage investments in health. This paper provides evidence from a randomized experiment that provided mature adults aged 45+ in Malawi with information about mortality risks. Treated individuals are less likely to engage in risky sexual practices one year after the intervention, and they increase other forward-looking behaviors such as investments in agriculture. Expectations of HIV+ people living longer, which makes the pool of potential partners riskier, are a primary driver of reduced sexual risk taking in response to the intervention. PublicationHealth Screening for Emerging and Non-Communicable Disease Burdens Among the Global Poor(2021-01-26) Ciancio, Alberto; Kämpfen, Fabrice; Kohler, Hans-Peter; Kohler, Iliana V.; Ciancio, Alberto; Kämpfen, Fabrice; Kohler, Hans-Peter; Kohler, Iliana V.Among adults in rural Malawi, population health screening for high blood pressure (BP) led to a 22-percentage point drop in the likelihood of being hypertensive four years later. Individuals with elevated BP received a referral letter upon initial screening; at follow-up, they had lower BP and higher self-reported mental health than individuals with similar BP who were just below the threshold for referral. Population health screenings can reduce the burden of non-communicable diseases in low-income countries. PublicationThe Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC)(2020-01-28) Kohler, Iliana V.; Bandawe, Chiwoza; Ciancio, Alberto; Kämpfen, Fabrice; Payne, Collin F.; Mwera, James; Mkandawire, James; Kohler, Hans-Peter; Kohler, Iliana V.; Bandawe, Chiwoza; Ciancio, Alberto; Kämpfen, Fabrice; Payne, Collin F.; Mwera, James; Mkandawire, James; Kohler, Hans-PeterCohort purpose: The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) contributes to global aging studies by providing a rare opportunity to study the processes of individual and population aging, the public health and social challenges associated with aging and the coincident shifts in disease burdens, in a low-income, high HIV prevalence, sub-Saharan African (SSA) context. Design and Measures: The MLSFH-MAC is a population-based cohort study of mature adults aged 45 years and older living in rural communities in three districts in Malawi (Mchinji, Balaka and Rumphi). Initial enrollment at baseline is 1,266 individuals in 2012. MLSFH-MAC follow-ups were in 2013, 2017, and 2018. Survey instruments cover aging-related topics such as cognitive and mental health, NCDs and related health literacy, subjective survival expectations, measured biomarkers including HIV, grip strength, hypertension, fasting glucose, BMI, a broad range of individual- and household-level social and economic information, a 2018 qualitative survey of mature adults and community officials, 2019 surveys of village heads, health care facilities and health care providers in the MLSFH-MAC study areas. Unique features: MLSFH-MAC is a data resource that covers 20 years of the life course of cohort members and provides a wealth of information unprecedented for aging studies in a low-income SSA context that broadly represents the socioeconomic environment of millions of individuals in south-eastern Africa. Among these are the longitudinal population-based data on depression and anxiety using clinically-validated instruments. MLSFH-MAC is also vanguard in measuring longitudinal changes in cognitive health among older individuals in SSA. Complemented by contextual and qualitative information, the extensive MLSFH-MAC data facilitate a life-course perspective on aging that reflects the dynamic and distinct settings in which people reach older ages in SSA LICs. Across many domains, MLSFH-MAC also allows for comparative research with global aging studies through harmonized measures and instruments. Collaboration and data access: Public-use version of the 2012 (baseline) MLSFH-MAC data can be requested at http://www.malawi.pop.upenn.edu. Sharing of additional MLSFH-MAC data is currently possible as part of collaborative research projects (if not overlapping with ongoing research projects, and subject to a Data Use Agreement). PublicationKnow Your Epidemic, Know Your Response: COVID-19 in the United States(2020-03-31) Ciancio, Alberto; Kämpfen, Fabrice; Kohler, Iliana V.; Ciancio, Alberto; Kämpfen, Fabrice; Kohler, Iliana V.; Bennett, Daniel; Kohler, Hans-Peter; Darling, Jill; Kapteyn, Arie; Maurer, Jürgen; Kohler, Hans-PeterWe document that during the week of March 10-16, the Covid-19 pandemic fundamentally affected the perceptions of U.S. residents about the health risks and socioeconomic consequences entailed by the pandemic. During this week, it seems, "everything changed." Not only did the pandemic progress rapidly across the United States, but U.S. residents started to realize that the threat was real: increasing Covid-19 caseloads heightened perceptions of infection risks and excess mortality risks, concerns about the economic implications increased substantially, and behavioral responses became widespread as the pandemic expanded rapidly in the U.S. In early to mid-March 2020, average perceptions about the coronavirus infection risks are broadly consistent with projections about the pandemic, while expectations about dying conditional on infection and expectations about Covid-19-related excess mortality during the next months are possibly too pessimistic. However, some aspects of Covid-19 perceptions are disconcerting from the perspective of implementing and sustaining an effective societal response to the pandemic. For instance, the education gradient in expected infection risks entails the possibility of having different perceptions of the reality of the pandemic between people with and without a college education, potentially resulting in two different levels of behavioral and policy-responses across individuals and regions. Unless addressed by effective health communication that reaches individuals across all social strata, some of the misperceptions about Covid-19 epidemic raise concerns about the ability of the United States to implement and sustain the widespread and harsh policies that are required to curtail the pandemic. Our analyses also reveal perceptions of becoming infected with the virus, and dying from Covid-19, were driven upwards by a rapidly increasing national caseload, and perceptions of the economic consequences and the adaptation of social distancing were affected by both national and state-level cases. PublicationHealth Screening for Emerging Disease Burdens Among the Global Poor(2020-02-14) Ciancio, Alberto; Kämpfen, Fabrice; Kohler, Hans-Peter; Kohler, Iliana V.; Ciancio, Alberto; Kämpfen, Fabrice; Kohler, Hans-Peter; Kohler, Iliana V.Evidence for the effectiveness of population health screenings to reduce the burden of non-communicable diseases in low income countries remains very limited. We investigate the sustained effects of a health screening in Malawi where individuals received a referral letter if they had elevated blood pressure. Using a regression discontinuity design and a matching estimator, we find that receiving a referral letter reduced blood pressure and the probability of being hypertensive by about 22 percentage points four years later. These lasting effects are explained by a 20 percentage points increase in the probability of being diagnosed with hypertension. There is also evidence of an increase in the uptake of medication, while we do not identify improvements in hypertension-related knowledge or risk behaviors. The health screening had some positive effects on mental health. Overall, this study suggests that population-based hypertension screening interventions are an effective tool to improve health in low-income contexts.